Improving the Health Insurance Marketplace

An AMA policy series, Improving the Health Insurance Marketplace, covers topics and actions to promote a strong health insurance market that benefits both patients and physicians. The series puts forward policy proposals to strengthen the impact of reforms in the Affordable Care Act, as well as guide state-level health reform proposals.

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The Overview (PDF) provides a summary of topics covered in the white paper series, and includes strategies the AMA believes should be implemented to support the development of strong and competitive health insurance markets through which individuals and families can purchase affordable health insurance that meets their health care needs.

In Network Adequacy (PDF), the AMA supports state regulators as primary enforcers of network adequacy requirements, quarterly reporting on network adequacy, financial protections to those who seek out-of-network care, accurate provider directories; and public availability of health plan participation criteria for physicians.

Health Insurance Subsidies (PDF) explains the AMA’s support for a system of individually-owned health insurance, supported by the provision of direct subsidies, to reform the individual health insurance marketplace by increasing the health coverage choices for individuals and families.

In the white paper Essential Health Benefits (EHB) (PDF), the AMA supports maximizing the choice of benefits packages for adults; using the Medicaid program’s Early and Periodic Screening, Diagnostic, and Treatment benefits as the model for any EHB package for children; and minimizing state benefit mandates to ensure health insurance coverage affordability.

The Individual Responsibility (PDF) white paper discusses AMA policy that supports a requirement that individuals and families who can afford health insurance be required to obtain it, using the tax structure to achieve compliance.

Guaranteed Issue and Renewability (PDF) outlines how the AMA supports the elimination of denials of health insurance coverage due to pre-existing conditions when an individual mandate is in place by requiring health insurers to provide guaranteed issue and guaranteed renewability.

Modified Community Rating (PDF) addresses AMA’s support for modified community rating, allowing health insurance premiums to vary based on certain individual risk factors, including age and tobacco use.

Patient Navigators (PDF) outlines AMA support for guidelines for patient navigator programs, which state that patient navigators should: communicate directly with the patient’s physician or medical team; fully disclose potential conflicts of interest to those whom they serve; refrain from any activity that could be construed as clinical in nature; and fully disclose relevant training, experience and credentials.

Basic Health Program (PDF) portrays the AMA’s support of 12-month continuous eligibility across Medicaid, CHIP and exchange plans to limit patient churn and promote the continuity of care. It also outlines guidelines for state Basic Health Programs to follow.

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